ENDOSCOPIC SNARE COMBINED WITH A CLIP APPLIER
An elongated endoscopic apparatus has an elongated catheter provided with a snare provision for performing a snaring procedure, a surgery clip, and a clip applier for clipping the wound left by the snaring procedure with the surgery clip. Preferably the elongated catheter is formed with an elongated inner tubular conduit that can accommodate a plurality of surgery clips, each having a C-shape characterized by a pair of elongated jaws mated together at a hinge end, wherein the jaws have tip ends forming the head end for the clip and hinge end forms the tail end for the clip when said plurality of clips are loaded into core of the inner tubular conduit in head to tail procession. The clip applier dispenses the clips a single at a time.
This application claims the benefit of U.S. Provisional Application No. 62/002,691, filed May 23, 2014; and U.S. Provisional Application No. 62/016,717, filed Jun. 25, 2014.
This application is a continuation-in-part of U.S. patent application Ser. No. 14/276,513, filed May 13, 2014, which claims the benefit of U.S. Provisional Application No. 61/961,842, filed Oct. 24, 2013; U.S. Provisional Application No. 61/957,306, accorded filing date of Jun. 29, 2013; and, U.S. Provisional Application No. 61/855,313, accorded filing date of May 14, 2013.
The foregoing disclosures are incorporated herein by this reference thereto.
BACKGROUND AND SUMMARY OF THE INVENTIONThe invention relates to surgical instruments and, more particularly, to endoscopic apparatus in which a snare provision for performing polypectomy procedures and the like is combined with a clip applier for clipping the wound left by the snaring operation.
A number of additional features and objects will be apparent in connection with the following discussion of the preferred embodiments and examples with reference to the drawings.
There are shown in the drawings certain exemplary embodiments of the invention as presently preferred. It should be understood that the invention is not limited to the embodiments disclosed as examples, and is capable of variation within the scope of the skills of a person having ordinary skill in the art to which the invention pertains. In the drawings,
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- the lower ovate opening comprises the dispensing end 220 of the passageway 222 for the procession of surgery clips 211, and the lead clip 211LD is visible too;
- the central opening is the access opening 224 for the extension and retraction of the snare provision 204;
- the upper left set of concentric circles represents a camera 226;
- the upper right pair of concentric circles represents a source 228 of illumination; and
- the thin rectangular slot above the snare provision comprises a water nozzle 232 for irrigation purposes.
Returning to
So in
To return to
In
Briefly, the clips 211 comprise jaws 258 which lead the way in the procession, and behind the jaws 258 the clips 211 then have trailing lever protrusions 272, wherein the jaws 258 and lever protrusions 272 meet at the pivot (or a hinge) therebetween. The lever protrusions 272 of the lead clip 211LD are stuffed into the jaws 258 of the second clip 211NX (ie., the succeeding clip). Thus the natural bias of the horseshoe-shaped spring 264 cannot force the ‘molars’ 270 of the second clip 211NX to close. Also, the passageway 222 is very close fitting around the procession of the clips 211. Thus also, the natural bias of the two springs 266 that want to flare open the ‘gums’ 268 of the clips 211 are constrained as well.
At last, attention can be returned to
While so embraced, the operator (eg., surgeon) then executes the closing of the noose of the snare 234, thereby severing off the bulb 242. If the operator can withdraw the terminal end 238 from the lead clip 211LD, and leave it there in place, then the lead clip 211LD might stay in place. As soon as the trailing lever protrusions 272 of the lead clip 211LD slip out of the jaws 258 of the second clip 211NX, then the ‘molars’ 270 of the lead clip 211LD ‘bite,’ ie., apply a clamping pressure on the stem 246 of the polyp 244.
The dispensing end 220 of the clip passageway 222 of the endoscopic apparatus 200 in accordance with the invention could be provided with the following. That is, the dispensing end 220 could be provided with a mechanism for positively launching the lead clip 211LD (ie., separating it from the second clip 211NX or, if the last clip 211ST of procession, the urging/ejecting plunger 274 on the last clip 211ST, and see
In all the clips 211 through 215, the jaws meet at a U-shaped bight which forms the pivot (or hinge) for the jaws 258. In
That way, the following sequence of events can take place. The snare 234 is looped over the bulb 242 of the polyp 244, and then brought to encircle the stem 246 proximate the bulb 242. The lead clip 215 can be extended and positioned to have its flaring jaws 258 embrace the stem 246. After that, the snare 234 can be tightened in an ever closing noose at the same time that the tightening snare 234 tugs the stem 246 against the razor edge 278 at the back of the U-shaped bight of the clip 215.
In other words, there are two things working together to do the one job of severing the bulb 242 (or whatever other target anatomy). The tightening encirclement of the snare 234, also pulling the stem 246 against the razor edge 278 at the back of the U-shaped bight of the clip 215.
In these views, the snare provision 284 and the dispensing of clips 216/217 is accomplished as both issuing from a common single lumen 288 in the catheter 282 of the elongated endoscopic apparatus 280 in accordance with the invention.
FIGS. 22 and 24-27 show how the clips 216/217 are modified for this implementation by having a recessed groove 290 in them for the snare 234 (or a sleeve for the snare, not shown but see
The invention having been disclosed in connection with the foregoing variations and examples, additional variations will now be apparent to persons skilled in the art. The invention is not intended to be limited to the variations specifically mentioned, and accordingly reference should be made to the appended claims rather than the foregoing discussion of preferred examples, to assess the scope of the invention in which exclusive rights are claimed.
Claims
1. An elongated endoscopic apparatus, comprising:
- a snare provision for performing a snaring procedure;
- a surgery clip; and
- a clip applier for clipping the wound left by the snaring procedure with the clip.
2. The elongate endoscopic apparatus of claim 1, wherein:
- the snare provision is arranged and configured for performing a polypectomy procedure.
3. The elongate endoscopic apparatus of claim 1, further comprising:
- an elongated catheter having defined therein an elongated inner tubular conduit;
- a plurality of surgery clips, each having a C-shape characterized by a pair of elongated jaws mated together at a hinge end, wherein the jaws have tip ends forming the head end for the clip and hinge end forms the tail end for the clip when said plurality of clips are loaded into core of the inner tubular conduit in head to tail procession; and
- a plunger rod for pushing the line of clips through the core of the inner tubular conduit at an incrementally indexed or metered rate of one clip at a time.
4. An elongated endoscopic apparatus, comprising:
- an elongated catheter terminating in a dispensing end;
- a snare provision; and
- a surgery clip; and
- a clip applier for dispensing the clip from the dispensing end of the elongated catheter;
- wherein said elongated catheter is formed with one elongated inner tubular conduit having an opening through the dispensing end and for use by the snare provision, as well as, another elongated inner tubular conduit having a respective opening through the dispensing end and for use by the clip applier.
5. The elongated endoscopic apparatus of claim 4, wherein:
- said surgery clip has a C-shape characterized by a pair of elongated jaws mated together at a tail end, wherein the jaws have tip ends forming the head end for the clip;
- said clip applier comprises said surgery clip loaded into said other inner tubular conduit for the tip ends of the jaws to dispense out the opening of said other tubular conduit with the tail end trailing, and, a plunger rod for pushing the clip out of said other inner tubular conduit.
6. The elongated endoscopic apparatus of claim 5, wherein:
- said snare provision comprises a wire snare loop having an extension and a retraction stroke out of the opening through the dispensing end for said one inner tubular conduit.
7. The elongated endoscopic apparatus of claim 6, wherein:
- said wire snare loop is generally contained in one plane;
- said clip is can be partitioned in two by another plane that partitions each jaw in two and the tail end in two (eg., FIG. 5); and
- said wire snare loop is oriented in the one inner tubular conduit and said clip is cooperatively oriented in the other tubular conduit such that said one and said other plane are generally co-planar (eg., FIG. 4 or 8);
- whereby the snare provision and clip applier can be worked cooperatively to remove the bulb end of a peduncular-style polyp with the clip left behind pinching the stem proximate the anatomical wall to which the polyp is attached.
8. The elongated endoscopic apparatus of claim 7, further comprising:
- a plurality of said surgery clips, loaded into the core of said other inner tubular conduit in head to tail procession;
- whereby said plunger rod is controllable for pushing the line of clips through the core of said other inner tubular conduit at an incrementally indexed or metered rate of one clip at a time.
9. An elongated endoscopic apparatus, comprising:
- an elongated catheter terminating in a dispensing end;
- a snare provision; and
- a surgery clip; and
- a clip applier for dispensing the clip from the dispensing end;
- wherein said elongated catheter is formed with a common lumen having an opening through the dispensing end and for use by both the snare provision and the clip applier.
10. The elongated endoscopic apparatus of claim 9, wherein:
- said surgery clip has a C-shape characterized by a pair of elongated jaws mated together at a tail end, wherein the jaws have tip ends forming the head end for the clip;
- said clip applier comprises said surgery clip loaded into said common lumen for the tip ends of the jaws to dispense out the opening therefor, and, a plunger rod for pushing the clip out the opening.
11. The elongated endoscopic apparatus of claim 10, wherein:
- said snare provision comprises a wire snare loop having an extension and a retraction stroke out of the opening of the common lumen.
12. The elongated endoscopic apparatus of claim 11, wherein:
- said wire snare loop is generally contained in one plane;
- said clip is can be partitioned in two by another plane that partitions each jaw in two and the tail end in two (eg., FIG. 28); and
- said wire snare loop is oriented in the one inner tubular conduit and said clip is cooperatively oriented in the other tubular conduit such that said one and said other plane are generally co-planar (eg., FIG. 23);
- whereby the snare provision and clip applier can be worked cooperatively to remove the bulb end of a peduncular-style polyp with the clip left behind pinching the stem proximate the anatomical wall to which the polyp is attached.
13. The elongated endoscopic apparatus of claim 12, wherein:
- said clip further comprises an axially extending recessed groove (290) formed through the tail end for the snare provision to operate therein.
14. The elongated endoscopic apparatus of claim 12, further comprising:
- a plurality of said surgery clips, loaded into the core of said other inner tubular conduit in head to tail procession;
- whereby said plunger rod is controllable for pushing the line of clips through the core of said other inner tubular conduit at an incrementally indexed or metered rate of one clip at a time.
15. The elongated endoscopic apparatus of claim 11, wherein:
- said clip further comprises an axially extending recessed groove (290) formed through the tail end for the snare provision to operate therein.
16. The elongated endoscopic apparatus of claim 9, further comprising:
- a plurality of said surgery clips, loaded into the core of said other inner tubular conduit in head to tail procession; and
- a plunger rod for pushing the line of clips through the core of said common lumen at an incrementally indexed or metered rate of one clip at a time.
17. The elongated endoscopic apparatus of claim 16, wherein:
- each said surgery clip has a C-shape characterized by a pair of elongated jaws mated together at a tail end, wherein the jaws have tip ends forming the head end for the clip; and
- each clip further has an axially extending recessed groove (290) formed through the tail end for the snare provision to operate therein.
18. The elongated endoscopic apparatus of claim 17, wherein:
- said snare provision comprises a wire snare loop having an extension and a retraction stroke out of the opening of the common lumen, and said wire snare loop is generally contained in one plane;
- said clips can be partitioned in two by another plane that partitions each jaw in two and the tail end in two (eg., FIG. 28); and
- said wire snare loop and said procession of clips are cooperatively oriented in the common lumen therefor such that said one and said other plane are generally co-planar (eg., FIG. 23);
- whereby the snare provision and clip applier can be worked cooperatively to remove the bulb end of a peduncular-style polyp with at least one clip left behind pinching the stem proximate the anatomical wall to which the polyp is attached.
19. The elongated endoscopic apparatus of claim 18, wherein:
- the head end of the clips and the tail end of the clips are formed with interfitting provisions such that when formed up in a line in the core of the common lumen, the plurality of clips maintain a relative angular orientation with respect to one another whereby the axially extending recessed grooves (290) of the procession of chips align on a common axially extending longitudinal axis (eg., FIG. 28 or 23).
20. The elongated endoscopic apparatus of claim 9, further comprising:
- a source of illumination and a camera, both disposed at the dispensing end of said catheter.
Type: Application
Filed: May 26, 2015
Publication Date: Dec 31, 2015
Inventor: Mubashir H. Khan (Springfield)
Application Number: 14/721,312